评估南非比勒陀利亚Dr George Mukhari学术医院脑室腹腔分流脓毒症的发生率和危险因素

IF 0.4 Q4 CLINICAL NEUROLOGY

Interdisciplinary Neurosurgery: Advanced Techniques and Case Management Pub Date : 2025-06-01 DOI:10.1016/j.inat.2025.102067

Andries Pretorius , Adrian Kelly , Patrick Lekgwara

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引用次数: 0

摘要

高压性脑积水患者是我院神经外科的常见转诊病例。材料和方法一项描述性横断面研究，在2014年1月1日至2022年11月30日期间连续纳入335名接受脑室-腹膜分流术的受试者，旨在确定我国局部脑室-腹膜分流术脓毒症的发生率，并在3个月的随访中进一步评估脑室-腹膜分流术脓毒症的已知危险因素。结果本研究共置入335例脑室-腹膜分流管，其中儿童190例（57%），成人145例（43%）。关于脑积水的原因，90/335（26.9%）的受试者为先天性，45/335（13%）的受试者为原发性轴内中枢神经系统肿瘤，40/335（12%）的受试者为脑室内出血，38/335（11%）的受试者为脊膜膨出。考虑到脑室-腹腔分流术感染的发生率，28/335（8.4%）的受试者在手术后3个月内出现了这种并发症。在评估脑室-腹膜分流器脓毒症已知危险因素的重要性时，我们的研究表明，在急诊室进行脑室-腹膜分流器置入（p = 0.02, OR 1.87, CI 0.83-4.23）、在夜间置入脑室-腹膜分流器（p = 0.03, OR 3.92, CI 1.13-13.58）、有脑室-腹膜分流器脓毒症病史（p = 0.004, OR 7.34, CI 2.20-24.55）、在脑室-腹膜分流术插入时临床免疫抑制（p = 0.03, OR 3.01, CI 1.09-8.32），以及术后脑脊液漏（p = 0.04, OR 5.19, CI 0.91-29.71），在预测脑室-腹膜分流术败血症发生方面具有重要意义。结论我们的研究证实了我们的机构脑室腹腔分流脓毒症发生率为8.4%，进一步证实了文献中几个已知危险因素的重要性。

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Evaluating the incidence and risk factors for ventriculoperitoneal shunt sepsis at Dr George Mukhari Academic hospital in Pretoria, South Africa

Introduction

Patients with increased pressure hydrocephalus are a common referral to the Department of Neurosurgery at our institution.

Materials and methods

A descriptive cross-sectional study performed by consecutively enrolling 335 subjects who underwent a ventriculoperitoneal shunt insertion between the 01 January 2014 – 30 November 2022, aimed to establish our local ventriculoperitoneal shunt sepsis incidence, and further evaluate the known risk factors for ventriculoperitoneal shunt sepsis at 3- month follow-up.

Results

In our study 335 ventriculoperitoneal shunts were inserted, 190 (57 %) were inserted in children and 145 (43 %) were inserted in adults. With regards the cause of hydrocephalus in 90/335 (26.9 %) subjects this was congenital, in 45/335 (13 %) subjects this was a primary intra-axial CNS tumor, in 40/335 (12 %) subjects this was intraventricular hemorrhage, and in 38/335 (11 %) subjects this was in subjects with a myelomeningocele. Considering the ventriculoperitoneal shunt infection incidence 28/335 (8.4 %) subjects developed this complication within 3 months of the procedure. In evaluating the significance of the known risk factors for ventriculoperitoneal shunt sepsis, our study demonstrated that having a ventriculoperitoneal shunt insertion performed in the emergency theatre (p = 0.02, OR 1.87, CI 0.83–4.23), having a ventriculoperitoneal shunt inserted at night (p = 0.03, OR 3.92, CI 1.13–13.58), having a history of ventriculoperitoneal shunt sepsis (p = 0.004, OR 7.34, CI 2.20–24.55), being clinically immunosuppressed at the time of the ventriculoperitoneal shunt insertion procedure (p = 0.03, OR 3.01, CI 1.09–8.32), and having a post-operative cerebrospinal fluid leak (p = 0.04, OR 5.19, CI 0.91–29.71), demonstrated significance in predicting that ventriculoperitoneal shunt sepsis would occur.

Conclusion

Our study confirmed that our institutional ventriculoperitoneal shunt sepsis rate is 8.4 % and furthermore confirmed the significance of several of the known risk factors as taken from the literature.

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